Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, United States of America.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America.
PLoS One. 2020 Nov 24;15(11):e0242823. doi: 10.1371/journal.pone.0242823. eCollection 2020.
Hurricanes Katrina and Sandy were two of the most significant disasters of the 21st century that critically impacted communities and the health of their residents. Despite the assumption that disasters affect access to healthcare, to our knowledge prior studies have not rigorously examined availability of healthcare providers following disasters.
The objective of this study was to examine availability of healthcare providers following large-scale hurricanes.
Using historical data on healthcare providers from the National Plan and Provider Enumeration System and county-level population characteristics, we conducted a quasi-experimental study to examine the effect of large-scale hurricanes on healthcare provider availability in the short-term and long-term. We separately examined availability of primary care physicians, medical specialists, surgeons, and nurse practitioners. A difference-in-differences analysis was used to control for time variant factors comparing county-level health care provider availability in affected and unaffected counties the year before Hurricanes Katrina and Sandy, to five years after each storm.
Counties affected by Hurricane Katrina compared to unaffected locales experienced a decrease of 3.59 primary care physicians per 10,000 population (95% CI: -6.5, -0.7), medical specialists (decrease of 5.9 providers per 10,000 (95% CI: -11.3, -0.5)), and surgeons (decrease of 2.1 (95% CI: -3.8, -0.37)). However, availability of nurse practitioners did not change appreciably. Counties affected by Hurricane Sandy exhibited less pronounced changes. Changes in availability of primary care physicians, nurse practitioners, medical specialists, and surgeons were not statistically significant.
Large-scale hurricanes appear to affect availability of healthcare providers for up to several years following impact of the storm. Effects vary depending on the characteristics of the community. Primary care physicians and medical specialists availability was the most impacted, potentially having long-term implications for population health in the context of disaster recovery.
卡特里娜飓风和桑迪飓风是 21 世纪影响最为严重的两次灾害，对社区及其居民的健康造成了严重影响。尽管人们认为灾害会影响医疗保健的可及性，但据我们所知，之前的研究并未严格检查灾害后医疗保健提供者的可用性。
本研究旨在检查大规模飓风后医疗保健提供者的可用性。
我们使用国家计划和提供者登记系统的医疗保健提供者历史数据以及县一级人口特征，进行了一项准实验研究，以检查大规模飓风对短期和长期医疗保健提供者可用性的影响。我们分别检查了初级保健医生、医学专家、外科医生和执业护士的可用性。差异中的差异分析用于控制时间变量，比较卡特里娜飓风和桑迪飓风前一年受灾和未受灾县的县级医疗保健提供者可用性，以及每次风暴后五年的情况。
与未受灾地区相比，受卡特里娜飓风影响的县每 10000 人减少了 3.59 名初级保健医生（95%CI：-6.5，-0.7）、医学专家（每 10000 人减少了 5.9 名提供者（95%CI：-11.3，-0.5））和外科医生（减少了 2.1 名（95%CI：-3.8，-0.37））。然而，执业护士的可用性并没有明显变化。受桑迪飓风影响的县变化幅度较小。初级保健医生、执业护士、医学专家和外科医生可用性的变化没有统计学意义。
大规模飓风似乎会影响风暴影响后数年的医疗保健提供者的可用性。影响因社区的特点而异。初级保健医生和医学专家的可用性受到的影响最大，这可能对灾害恢复背景下的人口健康产生长期影响。
